HPV

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October 15, 2013 | 3:35 PM | Rachel Bloom

Public health officials have been somewhat puzzled by low rates of HPV vaccination: only 54% of adolescent girls receive the first dose of the 3-part vaccine series, and only 33% complete it.

What gives? Doctors recommend it. It’s safe and effective. It has the potential to save thousands of lives every year. So why aren’t more people getting the HPV vaccine?

A young girl after getting the HPV vaccine

A new study by doctors and public health researchers at the University of Colorado sheds light on who remains unvaccinated and why. (While the full article has not yet been released, the authors recently presented their research with an abstract and poster.) It builds on previous findings that deserve mention: women of low socioeconomic status have the highest risk of developing cervical cancer because of their limited access to other preventative measures, like annual exams and pap smears. In other words, poor women need the HPV vaccine the most. But among the girls who begin the vaccine series, minorities and the impoverished are much less likely to complete it.

To find out why, the researchers, led by Sean O’Leary, MD, MPH, interviewed the parents of girls with an incomplete HPV vaccination. They recruited both English-speaking and Spanish-speaking parents for the study to see if there were any major differences in reasoning or access to care.

As it turns out, two big issues appear to be at play here: parents don’t understand the importance of completing the vaccine series, and healthcare providers aren’t following up about scheduling doses 2 and 3. Spanish-speaking parents had particular trouble with the latter; one parent reported that their provider was “not clear on when to get the next [shot in the series],” even though they wanted their daughter to complete the series “because we are responsible.”

What we’re looking at, it seems, is a bit of a break-down in doctor-patient communication. Continue reading →

September 23, 2013 | 6:00 AM | Rachel Zimmerman and Carey Goldberg

Somehow, over the last few years, one of modern medicine’s greatest achievements has turned into one of modern American parents’ most fraught subjects.

In this episode of The Checkup, our podcast on Slate, we offer Shots: Vaccine Facts And Fictions, in which we attempt to have a rational, fact-based discussion about some of the vaccines you may encounter in the immediate future: the flu vaccine and, if you have pre-adolescent children, the HPV vaccine.

(To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

This year’s flu vaccines offer consumers more choices than ever: there’s a nasal version, a quadrivalent (four-strain) option, a “short-needle” option and an egg-free vaccine for people with allergies, among others. And even though it still feels like summer in some parts of the country, doctors are urging people to get their flu shots early.

The HPV vaccine was introduced seven years ago but, according to the CDC, only about half of girls are getting one or more doses, and only about one-third are getting the full three-dose course. This despite word from public health officials that it’s highly effective for preventing HPV — the most common sexually transmitted infection in the U.S. and a principal cause of cervical cancer — and so far, pretty safe. (It’s recommended for boys as well as girls, both because boys can spread HPV and because there’s a notable rise in HPV-related cancers in older men. See: Michael Douglas and oral sex. )

Doctors say a variety of obstacles stand in the way of more widespread use of the HPV vaccine. There remains the stigma of a vaccine for a sexually transmitted infection. Also, when you’re talking about an 11-year-old, preventing cervical cancer may seem less urgent than, say, preventing measles. Finally, there’s a general sense of “vaccine fatigue” among parents bombarded with so many official recommendations and competing agendas.

For more info, check out this HPV fact sheet created by our intern, Rachel Bloom:

Readers, please let us know how you’re handling vaccines for your family this year. Anything we can learn from your experience?

Even though the HPV vaccine has been deemed safe and effective for protection against developing cervical cancer and certain head and neck cancers, only about half of U.S. girls have received the vaccine.

Here’s the latest from the CDC:

Despite the availability of safe and effective HPV vaccine, many girls remain unprotected for HPV infections and therefore HPV-related cancer and disease.

However, high HPV vaccination coverage is possible in the United States with existing infrastructure and healthcare utilization. HPV vaccination coverage of adolescent girls failed to increase from 2011 to 2012. Only 53.4 percent of girls received 1 or more doses of HPV vaccine and only 33.4 percent received the complete 3-dose series.

National safety monitoring data continue to indicate that HPV vaccine is safe. Large post-licensure studies have shown no serious safety concerns have been identified in seven years. However, despite the availability of safe and effective vaccines, many girls remain unprotected for HPV infections. If HPV vaccine was administered at healthcare encounters when other recommended vaccines were administered, vaccination coverage could be as high as 93 percent.

Improving providers’ practice patterns so they use every opportunity to offer HPV vaccines and are well-equipped to address questions from parents will be necessary to further reduce HPV-associated cancers.

…many are missing the shots even as they get other vaccinations during doctor visits, the Centers for Disease Control and Prevention says. That’s even though the vaccine is very effective and has already started to affect rates of infection with the human papilloma virus (HPV).

“One of the top reasons is their doctor didn’t recommend (it),” CDC director Dr. Tom Frieden tod reporters in a conference call.

“We are dropping the ball,” he added. “We are missing the opportunity to give HPV vaccine… This is a huge disappointment.”

Even so, studies have shown HPV infections fell by half after vaccines became available. “HPV vaccine works even better than we hoped,” Frieden says. “HPV vaccine is safe.”

Public health officials note that boys should get the vaccine too (see also: Michael Douglas and oral sex). Here’s the conclusion of an op-ed we ran last year by Paula A. Johnson, executive director of the Connors Center for Women’s Health and Gender Biology, and chief of the division of women’s health at Brigham and Women’s Hospital and Robert Haddad, chief of head and neck oncology at Dana Farber/Brigham and Women’s Cancer Center, and associate professor of medicine, Harvard Medical School:

The HPV vaccine cuts across gender lines. It is as much a male issue as a female issue. In addition to educating the public, the medical establishment needs to acknowledge the link HPV has to, not one, but many types of cancer. We need to educate parents of the risks so they can make informed decisions when it comes to protecting their children during routine vaccination visits. By moving away from viewing the HPV vaccine as a political, moral or religious flashpoint, we can finally embrace this vaccine for what it truly is, a vaccine that reduces our children’s risk for certain types of cancer, and what we hope will be the first in a long line of vaccines against cancer during our lifetimes.

Well, actually, turns out it can be. Here’s Saturday Night Live’s answer to the HPV vaccine controversy: a baby doll who smells like frosting called Lil Poundcake, with blond hair that grows and a hidden needle to administer injections to girls under 10. “Side effects include fever and nausea,” chirps the Lil Poundcake jingle, which also reminds moms to dispose of Lil Poundcake in the local hospital biohazard bin after use. “The only thing you’re gonna get infected with — is fun!!”

(Hat tip to Martha Bebinger, who apparently stays up later than the rest of us.)

The story drew a bunch of comments from Australians — kind of unusual for CommonHealth — including this one on Facebook from an old school friend of mine, Devora Lieberman, who is now an ob/gyn in Sydney:

“Australian data already showing a decline in high grade Pap abnormalities among the age group that was eligible for the free vaccine. An Australian invention, and our former Prime Minister’s wife had cervical cancer, so perhaps we’re biased, but I think the early results are in and are irrefutable.”

For three years, I’ve given my daughter a pass on the HPV vaccine, which prevents infection from the cancer-causing human papilloma virus.

The vaccine approved in 2006 was too new, I thought. I didn’t want to expose her to a shot that hadn’t been tested in millions of people for years and years. And she was too young for me to be concerned. HPV is passed sexually, and though the federal government recommends girls get the vaccine as young as age 9, my pediatrician agreed we should wait a few years.

My daughter started high school this month, though, and is scheduled for her 14-year-old physical in a few weeks.

I hope it’s still a few decades until she brings home her first boyfriend, but I can’t justify putting off my vaccine decision any longer.

That was already on my mind when presidential candidate Michele Bachmann wrongly suggested the vaccine caused mental retardation earlier this month. (Last night during another debate, Bachmann backed away slightly, saying she was simply recalling a story a mother had told her.)

So this week I looked at the data, and talked it over with my pediatrician, and I’ve decided she should get the vaccine.

Hoping my research might help someone else facing the same question, I thought I’d spell out what I’ve done and why I came to this conclusion: Continue reading →

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.GET IN TOUCH

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

If they’re so effective, why aren’t more women using IUDs and implants? A health clinic in Worcester is getting help to put better birth control front and center — particularly long-acting birth control, in hopes of cutting the high rate of unintended pregnancy.